Comparison of Clinical Outcomes of Silver-modified Atraumatic Restorative Technique vs Atraumatic Restorative Technique in Primary Teeth: A Randomized Controlled Trial

Abstract

Aim: To compare the clinical outcomes of silver-modified atraumatic restorative technique (SMART) vs atraumatic restorative technique (ART) in primary teeth. Materials and methods: This study was a randomized clinical trial conducted on 30 children. The study was split-mouth design, so each group was consisted of 30 children. Children aged 3–6 years old of both genders. Communication with the children was established. Gross debris from cavitation was removed. Carious dentin on walls was excavated using spoon excavator and low-speed contra with round or fissure bur. The areas to be treated were isolated with cotton rolls. For ART, glass ionomer cement (GIC) was applied according to the manufacturer's instructions. For silver-modified atraumatic restorative technique (SMART), a protective coating was applied to the lips and skin to prevent a temporary tattoo. Silver diamine fluoride (SDF) was applied carefully using bended microsponge brush. It was applied directly to only the affected tooth surface. The lesion was dried for 15 seconds with gentle flow of compressed air. After 1 week, GIC was applied according to the manufacturer's instructions. Clinical evaluation was done for all teeth at 6 and 12 months. The data were collected and then statistically analyzed using the Chi-square test to show the difference between groups. Results: The restoration of the first primary molar with ART restoration alone showed a lower success rate when compared with the restoration with a combination of SDF and ART (SMART technique), with percentages of 70% and 76.67% and 53.33% and 60% after 6 months and 12 months of follow-up, respectively. Conclusion: Silver diamine fluoride is successful in arresting dentin caries and can be used to increase the efficacy of the ART technique in primary teeth. Clinical significance: It is recommended to use SDF as a noninvasive approach to control dentin caries with the ART technique.